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DECEIVED <br /> WV 18 2021 <br /> GiVISION OF RECLAMATION <br /> MINING AND SA, 2TY <br /> An example Structure Agent which meets the requirements of the Statutes is shown below. <br /> Stm-LtMM Atli[Ment <br /> This letter has been provided to you as the owner of a shuctm on or within two hundred(200) <br /> fed of a proposed mine site.The State of Colorado,Division of Reclamation.Mining and Safety <br /> ("Division')requires that where a mmmg operation w01 adversely affect the stability of any significant, <br /> valuable and permanent man-made stsuctLn located within two hundred(2W)fed of the affected land, <br /> the Applicant shall either: <br /> a) Provide a notarized agreement between the Applicant and the Pason(s)having an interest in the <br /> shuchnre,that the Applicant is to provide compensation for any damage to the structure;or <br /> b) Where such an agreement cannot be reached,the Applicant shall provide an appropriate <br /> engineering evaluation that demonstrates that such shucture shall not be damaged by activities <br /> occurring at the mining operation;or <br /> c) Where such structure is a utility,the Applicant may supply a notarized Idler,on utility letterhead, <br /> firm the owner(a)of the utility that the mining and reclamation activities,as proposed,will have <br /> "no negative effect"on their utility.(Construction Materials Reek 6 3.12 and Rule 6.419&Hard <br /> RockWetal Mining Rule 6.3.12 and Rule 6.4.20) <br /> The Colorado Maeed land Redlamadon Board("Board")has determined that this form,If <br /> praperY saner kA r9raents an agreement that c=Plias with Consawcdon Materials Ruk 6 3.12(a), <br /> Rule 6.4.19(a),and CJU§34-32 5-115(4)(e)and with Hard Rock/Metal Mining Ruk 63.12(a),Ruk <br /> 6.4.20(a),and C U f 34-32-I1 S(4)(q). This force is for the sole pwpo►se of enacting compliance with the <br /> Rules and Regulations and shall not mane the Board or Division a necessary party to arty private devil <br /> lawsuit to enforce the terms of the agreement or create any enforcement obligations in the Board or the <br /> Division. <br /> Tke 66orwing structures are located an or wims 20t1 lest of Sc proposed affected area; <br /> I. <br /> 2. 0-kaisq,evyk 'PAPj .* <br /> 3. &041%1% tZC U <br /> 4. -DA Eta `t�KA <br /> s. �,l1h.Pnl� vsh <br /> (Pldw list additional mucturar an a sgwwepW) <br />